The effect of real time 2-D-echocardiography on medical decision-making in the emergency department

2-D Echocardiography (ECHO) represents an important tool for the evaluation of the Emergency Department (ED) patient with suspected cardiovascular (CV) pathology. The present study assesses the degree of effect of real time ECHO on Emergency Physician diagnosis, treatment, and disposition of CV patients and their level of confidence in these decisions. One hundred ED patients with suspected CV pathology were enrolled into this prospective, interventional study. Senior level physicians were asked their level of confidence regarding patient diagnosis, treatment, and disposition decisions before and after the ECHO was done and interpreted by a certified sonographer in the ED. Physicians were then asked if ECHO changed any of these decisions. Patient age was 56.4 +/- 15.8 (range 27-93) years. Chest pain (n = 45) and shortness of breath (n = 38) were the most common presenting symptoms. Eighty-six of the patients were admitted. There was a change in diagnosis in 37 patients, a change in treatment in 25 patients, and a change in disposition in 11 patients. Physicians indicated there was a change in confidence level post-ECHO in approximately 50% of patients. A significant change was seen in both a more and a less confident direction. Physicians were 3 times more confident regarding diagnosis, 7 times more confident regarding treatment, and 3 times more confident regarding disposition decision-making. Real time ECHO appears to have a significant level of impact on physician level of confidence and medical decision-making concerning patients with suspected cardiovascular pathology in the ED.